1447506795 NPI number — DR. MICHELLE LANPHERE LEE RD, LDN

Table of content: DR. MICHELLE LANPHERE LEE RD, LDN (NPI 1447506795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447506795 NPI number — DR. MICHELLE LANPHERE LEE RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
MICHELLE
Provider Middle Name:
LANPHERE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447506795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 70403
Provider Second Line Business Mailing Address:
807 UNIVERSITY PKWY
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37614-1703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-439-4071
Provider Business Mailing Address Fax Number:
423-439-4060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
BOX 70403
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37614-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-4071
Provider Business Practice Location Address Fax Number:
423-439-4060
Provider Enumeration Date:
07/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  LDN0000001467 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LDN1467 . This is a "ST LIC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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